Brigham & Women’s Hospital Harvard Medical School

Yoga in Schools

Sat Bir S. Khalsa, Ph.D.

Assistant Professor of Medicine, Harvard Medical SchoolDirector of Yoga Research, Yoga Alliance

Director of Research, Kundalini Research InstituteEditor in Chief, International Journal of Yoga Therapy

Research Associate, Benson Henry Institute for Mind Body MedicineResearch Affiliate, Osher Center for Integrative Medicine

Yoga Alliance WebinarMay 5, 2020

From: Yoga in America Market Study, Yoga Journal, 2008

From: Clarke TC, Barnes PM, Black LI, Stussman BJ, Nahin RL.Use of yoga, meditation, and chiropractors among U.S. adults aged 18 and older. NCHS Data Brief, no 325. Hyattsville, MD: National Center for Health Statistics. 2018.

U.S. Adult Yoga Demographics

YouthChallenges

19.0

15.6

22.3 22.7

20.3

18.3

14.013.2

16.3

21.5

0

20

Total Male Female 9th 10th 11th 12th Black Hispanic White

Per

cen

t

Percentage of High School Students Who Were Bullied on School Property

National Youth Risk Behavior Survey, 2017

National Youth Risk Behavior Survey, 2017

Percentage of High School Students Who Ever Drank Alcohol

60.458.1

62.6

47.7

58.0

66.4

71.7

51.3

64.761.7

0

20

40

60

Total Male Female 9th 10th 11th 12th Black Hispanic White

Per

cen

t

National Youth Risk Behavior Survey, 2017

Percentage of High School Students Who Ate Vegetables One or More Times Per Day

59.4 59.4 59.356.1

60.8 60.4 60.8

49.4

56.1

62.8

0

20

40

60

Total Male Female 9th 10th 11th 12th Black Hispanic White

Per

cen

t

National Youth Risk Behavior Survey, 2017Percentage of High School Students Who Were Physically Active at Least 60 Minutes Per Day

on 5 or More Days

46.5

56.9

36.8

54.1

45.0 45.1

41.4 42.044.9

48.7

0

20

40

60

Total Male Female 9th 10th 11th 12th Black Hispanic White

Per

cen

t

National Youth Risk Behavior Survey, 2017Percentage of High School Students Who Described Themselves As Slightly or Very

Overweight

31.5

25.3

37.5

30.5 29.7

33.832.3

28.1

37.1

29.9

0

20

40

Total Male Female 9th 10th 11th 12th Black Hispanic White

Per

cen

t

Stress is Taking a Physical and Emotional Health Toll on Children

…parents are underestimating how much stress their children experience and the impact their own stress has on their children.…children as young as eight years old are reporting that they experience physical and emotional health consequences often associated with stress.

Majority of seriously impairing andpersistent conditions have child-adolescent onsets and highcomorbidity

Need for treatment of largelyuntreated child-adolescentdisorders

From:One-year incidence of psychiatric disorders and associated risk factors among adolescents in the community. Roberts RE, Roberts CR, Chan W., Journal of Child Psychology and Psychiatry. 50:405-15, 2009.

“The most consistent factors involve indicators of stress…”“Personal resources (e.g. mastery) enhance resilience to onset”

Child-Adolescent Psychiatric Disorders

From: Estimating the burden of psychiatric disorders in adolescence: the impact of subthreshold disorders. Roberts RE, Fisher PW, Turner JB, Tang M. Social Psychiatry and Psychiatric Epidemiology, 50:397-406, 2015.

“…overall prevalence for at least one [subthreshold] disorderin the past year of…almost 16%...”

“One in four adolescents had either…disorder with impairment.”

From: Prevalence of Serious Emotional Disturbance Among U.S. Children: A Meta-Analysis. Williams NJ, Scott L, Aarons GA, Psychiatric Services, 69:32-40, 2018.

“…10.06% of youths experience [serious emotional disturbance] with substantial impairment in one or more functional domains…”“…large numbers of youth and families affected… underscore the need for comprehensive and effective prevention and treatment services.”

From: Cumulative prevalence of psychiatric disorders by young adulthood: a prospective cohort analysis from the Great Smoky Mountains Study, Copeland W, Shanahan L, Costello EJ, Angold A, Journal of the American Academy of Child and Adolescent Psychiatry, 50:252-61, 2011.

…the striking feature of the present data is...how high the rates of early psychiatric disorders are. Most likely, the lifetime prevalence of psychiatric problems by age 21 well exceeds 80%, suggesting that the experience of psychiatric illness is nearly universal.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3049293/pdf/nihms261148.pdf

National Youth Risk Behavior Survey, 2017

Percentage of High School Students Who Seriously Considered Attempting Suicide

17.2

11.9

22.1

16.317.3 17.5 17.4

14.7

16.417.3

0

20

Total Male Female 9th 10th 11th 12th Black Hispanic White

Per

cen

t

Adolescent / School Challenges

l Stress (developmental, family, social, academic, societal)

l Mental Health (depression, anxiety, substance abuse, trauma)

l Behavior (apathy, violence, social skills, bullying, absenteeism)

l Academics (grades, dropouts)

l Physical Health (obesity, diabetes)

l Attention (ADD, ADHD)

Yoga PracticesPostures, Breathing, Relaxation, Meditation

Fitness↑Flexibility↑Strength

↑Coordination/Balance ↑Respiratory Function

↑Self-Efficacy

Global Human Functionality↑Physical & Mental Health, ↑Physical Performance

↑Stress & Emotion Regulation, ↑Awareness/Mindfulness, ↑Meta-cognition↑Positive Behavior, ↑Wellbeing, ↑Values, ↑Life Purpose & Meaning, ↑Spirituality

Self-Regulation↑Stress Regulation

↑Emotion Regulation ↑Resilience ↑Equanimity

↑Self-Efficacy

Awareness↑Attention

↑Mindfulness↑Concentration

↑Cognition↑Meta-cognition

Spirituality↑Unitive State

↑Transcendence↑Flow

↑Transformation↑Life Meaning/Purpose

Yoga for Children/Adolescents

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2945853/pdf/PE_7_8_20.pdf

https://pediatrics.aappublications.org/content/pediatrics/138/3/e20161896.full-text.pdf

https://www.frontiersin.org/articles/10.3389/fped.2020.00078/pdf

Research Outcomes

l Physiological - Physical Functioning

l Psychological - Behavioral Functioning

l Cognitive Performance

Yoga in Schools

From: The Hygiene of the School Child, LM Terman, 1914.

… the health and welfare of a child will … be regarded as one of as much importance as arithmetic and geography…

Center for Disease ControlWhole School,

Whole Community,Whole Child Model

Collaborative forAcademic,

Social and EmotionalLearning (CASEL)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4831047/pdf/nihms-749696.pdf

Yoga in SchoolsResearch

https://www.frontiersin.org/articles/10.3389/fpsyt.2014.00035/pdf

http://downloads.hindawi.com/journals/ecam/2015/345835.pdf

From: Are There Benefits from Teaching Yoga at Schools? A Systematic Review of Randomized Control Trials of Yoga-Based Interventions, Ferreira-Vorkapic C Feitoza, Marchioro M, Simões J, Kozasa E, Telles S, Evidence-Based Complementary and Alternative Medicine, Article ID 345835, 2015.

Systematic Reviewof Yoga in Schools RCT’s

Research Outcomes

l Physiological - Physical Functioning

l Psychological - Behavioral Functioning

l Cognitive Performance

Adolescent / School Challenges

l Stress (developmental, family, social, academic, societal)

l Mental Health (depression, anxiety, substance abuse, trauma)

l Behavior (apathy, violence, social skills, bullying, absenteeism)

l Academics (grades, dropouts)

l Physical Health (obesity, diabetes)

l Attention (ADD, ADHD)

From: School-based yoga intervention increases adolescent resilience: a pilot trial. Felver JC, Razza R, Morton ML, Clawson AJ, Mannion RS, Journal of Child and Adolescent Mental Health, 17:1-10, 2020 (preprint).

Yoga for Social Emotional Learning

From: Self-Esteem and Performance in Attentional Tasks in School Children after 4½ Months of Yoga. Gulati K, Sharma SK, Telles S, Balkrishna A, International Journal of Yoga, 12(2):158-161, 2019.

Yoga for Cognitive Performance

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6521754/?report=printable

From: Comparison of Yoga versus Physical Exercise on Executive Function, Attention, and Working Memory in Adolescent Schoolchildren: A Randomized Controlled Trial. Vhavle SP, Rao RM, Manjunath NK, International Journal of Yoga, 12:172-173, 2019.

Yoga for Cognitive Performance

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6521753/?report=printable

Yoga for Academic Outcomes

From: Yoga May Mitigate Decreases in High School Grades, Butzer B, van Over M, Noggle Taylor JJ, Khalsa SBS, Evidence-Based Complementary and Alternative MedicineVolume, Article ID 259814, 2015.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5133199/pdf/nihms793008.pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5133199/pdf/nihms793008.pdf

• “I like to run, a lot. And it can usually go better when I feel flexible. And I’ve been feeling better when I run [since practicing yoga]. I also ski and the balance has helped a lot. I [do] better trails, harder trails now.”

• “I was motivated and inspired to practice yoga outside of class at home. It was great to have a form of exercise I found enjoyable and that felt good. I noticed myself changing: an increase in self awareness and it felt like instant gratification.”

• “I have been eating healthier, more fruits and vegetables and not a lot of junk food; [for example] ice cream and candy...”

Fitness and Behavior Change

From: A Qualitative Examination of Yoga for Middle School Adolescents, Butzer B, LoRusso AM, Windsor R, Riley F, Frame K, Khalsa SBS, Conboy L., Advances in School Mental Health Promotion, 10(3):195-219, 2017.

From: Qualitative evaluation of a high school yoga program: Feasibility and perceived benefits, Conboy LA, Noggle JJ, Frey JL, Kudesia RS, Khalsa SBS, Explore: The Journal of Science & Healing, 9:171-180, 2013.